Head and Neck Cancers
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Head and neck cancers are malignancies arising in the upper aerodigestive tract (this includes: lip, tongue, salivary glands, mouth, oropharynx, nasopharynx, hypopharynx, nasal cavity, and larynx). Laryngeal (voice-box) cancer is the most frequent type, accounting for about a quarter of head and neck cancers.

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Laryngeal Cancer
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Latest Research Publications

Head and Neck Cacer Resources (16 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Pérez-Mitchell C, Acosta JA, Ferrer-Torres LE
Robotic-assisted salvage supraglottic laryngectomy.
P R Health Sci J. 2014; 33(2):88-90 [PubMed] Related Publications
Traditional open surgery has historically been the standard approach to treating many head and neck conditions. The introduction of the first robot into the surgical world in 1985 has been a keystone in the development of minimally invasive surgical (MIS) techniques. Transoral robotic surgery (TORS) is a minimally invasive technique used for the treatment of head and neck pathologies, including benign and malignant lesions. When performed in select patients, TORS offers low post-operative morbidity, along with very few functional and cosmetic compromises. Herein, we present the first TORS supraglottic partial laryngectomy performed in Puerto Rico or in any region in Latin America. A 68-year-old male who had previously undergone radiation therapy presented with hoarseness and weight loss. A suspension microlaryngoscopy showed a lesion of the left false vocal cord; a biopsy was performed. The patient was diagnosed with a supraglottic squamous cell carcinoma (T2N0M0); the tumor was completely excised using TORS. No post-operative complications occurred.

Related: Cancer of the Larynx Laryngeal Cancer - Molecular Biology

Semple CJ, Killough SA
Quality of life issues in head and neck cancer.
Dent Update. 2014; 41(4):346-8, 351-3 [PubMed] Related Publications
Head and neck cancer (HNC) constitutes approximately 3% of all cancers in the UK, with in excess of 8500 new cases annually. Management of HNC depends on site, extent, histology, previous medical history and patient choice. A multidisciplinary approach is required to optimize patient wellbeing, owing to the significant functional and psychosocial implications that can impact on quality of life. Members of the dental team, to include the general dental practitioner, have a key role in patient care; therefore the dental team should be knowledgeable in the short-term and longer-term implications and how this impacts on quality of life. Clinical Relevance: This article offers the dental team with an overview of how HNC and the various treatments, such as surgery, radiotherapy and chemotherapy, impact upon quality of life, both in the short-term and longer-term.

Varinot J, Ménégaux F, Bitker MO, Compérat E
Renal metastasis from thyroid carcinoma: a case report.
Anal Quant Cytol Histol. 2014; 36(1):46-50 [PubMed] Related Publications
BACKGROUND: Renal metastases of thyroid carcinomas occur rarely and represent about 3% of all metastases to the kidney, with only 23 single case study reports in the English language literature.
CASE: A 77-year-old man presented with gross hematuria. CT scan showed a posterior and cortico-sinusal mass in the right kidney measuring 5 x 3 cm. On gross examination the kidney was occupied by a lobulated mass measuring 4.5 cm in its greatest dimension. Microscopically, there was a papillary and follicular proliferation with colloid-like materials in the intrafollicular space. The strong positive immunohistochemical stain of thyroglobulin and thyroid transcription factor-1 confirmed the origin of thyroid gland and the diagnosis of renal metastasis of thyroid carcinoma.
CONCLUSION: Although rare, the renal metastasis of a thyroid carcinoma is a diagnostic to consider even if the renal mass is unilateral and the patient has no history of thyroid surgery. The main differential diagnostic is the primitive thyroid-like follicular carcinoma of the kidney. Immunohistochemistry often leads to the right diagnosis, which is crucial for the management of the patient. Renal metastases of thyroid carcinomas are rare and often present as a primitive unilateral renal mass.

Related: Thyroid Cancer

Miladi S, Mestiri S, Kermani W, et al.
Metastasizing pleomorphic adenoma of the submandibular gland: a case report.
Pathologica. 2014; 106(1):29-31 [PubMed] Related Publications
Pleomorphic adenoma (PA), originally called mixed tumour, is the most common neoplasm of the salivary glands. It is usually a benign, slow-growing and well-circumscribed tumour. However, PA may occasionally give rise to metastases that usually occur after a previous recurrence. These tumours display benign histological features in both primary tumours and metastases. Such tumours have been termed metastatic PA or metastatic mixed tumours. We report a case of metastatic PA of the submandibular gland with metastasis to the cervical lymph nodes.

Chai TH, Jin XF, Li SH, et al.
A tandem trial of HD-NBI versus HD-WL to compare neoplasia miss rates in esophageal squamous cell carcinoma.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):120-4 [PubMed] Related Publications
BACKGROUND/AIMS: To determine whether the use of narrow-band imaging (NBI) system could enhance the detection rate of esophageal squamous cell carcinoma and precancerous lesions during endoscopic examination of the esophagus.
METHODOLOGY: 113 patients were randomized to undergo endoscopic examination using high definition television (HDTV) narrow band imaging (NBI) endoscopy or HDTV WL endoscopy. The primary endpoint was the difference in the neoplasm miss rate, and secondary outcome was the neoplasm detection rate.
RESULTS: The number of esophageal cancer and high grade intraepithelial neoplasia lesions detected by HD-NBI and HD-WL was 45 and 21, respectively. The neoplasm miss rate per lesion and per patient with HD-NBI showed significant difference compared with that of HD-WL (P <0.05). Characteristics of lesions missed by use of HD-NBI were similar to those missed by use of HD-WL; all missed lesions were high grade intraepithelial neoplasia lesions. Significant difference was observed between NBI and WL in adenoma detection rate (70.2% vs. 35.7%, P < 0.01).
CONCLUSIONS: Endoscopy with HD-NBI seems to improve the detection of esophageal cancer and precancerous lesions, high definition may be tested for its effect on detection of esophageal cancer and precancerous lesions in the future. These results indicate that endoscopy routinely using the NBI system for the surveillance of esophageal cancer and precancerous lesions may be recommended.

Related: Cancer Screening and Early Detection Cancer of the Esophagus Esophageal Cancer

Alldinger I, Schmitt MM, Dreesbach J, Knoefel WT
Endoscopic treatment of anastomotic leakage after esophagectomy or gastrectomy for carcinoma with self-expanding removable stents.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):111-4 [PubMed] Related Publications
BACKGROUND/AIMS: Anastomotic leakage is a feared complication after gastrectomy and esophagectomy. We report our experience in the treatment with endoscopic stent placement.
METHODOLOGY: Seventeen patients with anastomotic leakage after resection of a malignant tumor of the stomach or the distal esophagus have been long-term followed-up.
RESULTS: In 10 patients the implanted stent did successfully close the leakage in the first attempt. In 3 out of 7 patients with unsuccessfully sealed leakage a stent-in-stent-manoeuvre did successfully seal the leakage. We had no major complications upon implantation of the stents. We did have no recurrence of a once sealed leakage.
CONCLUSIONS: Endoscopic stent placement is a safe procedure in the treatment of anastomotic leakage after gastrectomy and esophagectomy. It should be performed in any clinically relevant leakage if possible. In cases where stent placement is not successful at first, correction of position, stent replacement or a stent-in-stent manoeuvre can be performed, with promising results.

Related: Cancer of the Esophagus Esophageal Cancer Stomach Cancer Gastric Cancer

Sato T, Nakamura T, Ota M, et al.
Improvement in the postoperative course of salvage esophagectomy after definitive chemoradiotherapy.
Hepatogastroenterology. 2014 Jan-Feb; 61(129):105-10 [PubMed] Related Publications
BACKGROUND/AIMS: The aim of this study was to assess the outcome of salvage esophagectomy with less extensive lymphadenectomy, which we have performed since 2003 to improve high mortality and morbidity of standard salvage esophagectomy.
METHODOLOGY: We retrospectively compared the surgical outcome of 15 patients who underwent standard salvage esophagectomy via right thoracotomy for thoracic esophageal cancer between 1993 and 2002 (earlier period) with the results of 11 patients between 2003 and 2011 (later period).
RESULTS: There were two mortalities in the earlier period, whereas no patient died in the later period, and there was a lower rate of morbidity. In the later period, there was a significantly shorter SIRS duration, lower CRP on postoperative days 1-5, and higher lymphocyte count on postoperative days 2-4. Long-term survival showed no significant difference between the two periods.
CONCLUSIONS: Salvage esophagectomy with less extensive lymphadenectomy might improve the surgical outcome while maintaining long-term survival.

Related: Cancer of the Esophagus Esophageal Cancer

Bombil I, Bentley A, Kruger D, Luvhengo TE
Incidental cancer in multinodular goitre post thyroidectomy.
S Afr J Surg. 2014; 52(1):5-9 [PubMed] Related Publications
BACKGROUND: The risk of malignancy in patients with multinodular goitre (MNG) is approximately 7.2%. The gold standard for diagnosis of thyroid cancer is fine-needle aspiration biopsy (FNAB). Unsuccessful, inconclusive or suspicious results mandate further investigations. The concern is that with a benign FNAB result there is no indication for surgery unless the patient has compression symptoms or cosmetic issues, but the risk of missed malignancy is nevertheless present.
OBJECTIVE: To determine the prevalence and histological features of incidental cancers in patients who had thyroidectomy for MNG.
METHOD: Records of patients who underwent thyroidectomy between January 2005 and December 2010 at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, were retrospectively reviewed. Data retrieved included demographic characteristics of the patients, type of thyroidectomy, thyroid function test results, FNAB cytology and final histology results.
RESULT: A total of 166 thyroidectomies were performed on 162 patients, the majority (139) of whom were females. The mean age was 46 years (range 15 - 79 years). A total of 120 pre-operative FNABs were available for analysis, 78 of which were suggestive of benign nodular goitre; 70 benign FNAB results were histologically confirmed to be MNG after thyroidectomy. Incidental malignancy was found in four of 70 cases of MNG (5.7%); all were papillary carcinomas, predominantly (75.0%) the follicular variant.
CONCLUSION: The risk of missing cancer in patients with MNG was 5.7%. The commonest histological subtype of thyroid cancer found in MNG was papillary carcinoma.

Related: Thyroid Cancer

Allison RR, Ambrad AA, Arshoun Y, et al.
Multi-institutional, randomized, double-blind, placebo-controlled trial to assess the efficacy of a mucoadhesive hydrogel (MuGard) in mitigating oral mucositis symptoms in patients being treated with chemoradiation therapy for cancers of the head and neck.
Cancer. 2014; 120(9):1433-40 [PubMed] Related Publications
BACKGROUND: The objective of this trial was to determine how a mucoadhesive hydrogel (MuGard), a marketed medical device, would fare when tested with the strictness of a conventional multi-institutional, double-blind, randomized, placebo-controlled study format.
METHODS: A total of 120 subjects planned to receive chemoradiation therapy (CRT) for treatment of head and neck cancers were randomized to receive either MuGard or sham control rinse (SC) during CRT. Subjects completed the validated Oral Mucositis Daily Questionnaire. Weight, opiate use, and World Health Organization (WHO) oral mucositis (OM) scores were recorded. Subjects who dosed at least once daily during the first 2.5 weeks of CRT were included in the efficacy analysis.
RESULTS: Of 120 subjects enrolled, 78 (SC, N=41; MuGard, N=37) were eligible for efficacy analysis. Both cohorts were similar in demographics, baseline characteristics, primary tumor type, and planned CRT regimen. MuGard effectively mitigated OM symptoms as reflected by area under the curve of daily patient-reported oral soreness (P=.034) and WHO scores on the last day of radiation therapy (P=.038). MuGard was also associated with nonsignificant trends related to therapeutic benefit including opioid use duration, and OM scores (WHO criteria) at CRT week 4. Rinse compliance was identical between cohorts. No significant adverse events were reported, and the adverse event incidence was similar between cohorts.
CONCLUSIONS: Testing MuGard, a rinse marketed as a device, in a standard clinical trial format demonstrated its superiority to SC in mitigating OM symptoms, delaying OM progression, and its safety and tolerability.

Yang X, Cole A, Oktay M, et al.
Fine needle aspiration of an unusual malignant mixed tumor in the parotid gland.
Lab Med. 2014; 45(2):141-6 [PubMed] Related Publications
OBJECTIVE: The use of fine needle aspiration (FNA) biopsy in the triage of salivary gland tumors has been well established. The sensitivity and specificity of FNA biopsy for tumor diagnosis is generally very good. However, the diagnosis can be challenging due to the limited amount of tissue sampled, the occasional overlapping tumor morphology, and the presence of a malignant counterpart of a benign tumor.
METHODS: FNA biopsy was performed with ultrasound guidance. Air-dried slides and alcohol-fixed slides were made for Diff-Quik staining and Papanicolaou staining, respectively. The syringes were rinsed and a cell block was prepared. The resected specimen was fixed in 10% formalin and processed by routine histology techniques.
RESULTS: We report a rare case of a salivary gland neoplasm with 2 distinct components: adenoid cystic carcinoma and pleomorphic adenoma. These 2 components are clearly identifiable in both cytological materials from fine needle aspiration and histological analysis of surgical resection.
CONCLUSION: Pleomorphic adenoma is the most common salivary gland tumor for patients in all age groups. The characteristic cytological feature is fibrillary extracellular matrix intermixed with epithelial cells. Malignant transformation occurs in 5% to 10% of cases. Rarely, pleomorphic adenoma exists as one component of a hybrid tumor. The surgical resection will be needed in those cases. The final diagnosis relies on the combination of the clinical information, histological findings and molecular study.

Bakkal BH, Ugur MB, Bahadir B
Bilateral synchronous squamous cell tonsil carcinoma treated with chemoradiotherapy.
J Pak Med Assoc. 2014; 64(4):468-70 [PubMed] Related Publications
The incidence of numerous head and neck tumours is a known issue though bilateral synchronous tonsillar carcinoma reports are so uncommon that only 20 cases were found in a literature review. Most of these patients were treated with bilateral tonsillectomy followed by adjuvant radiotherapy. We report, to our knowledge, the first case of bilateral synchronous tonsillar squamous cell carcinoma treated only with chemoradiotherapy without tonsillectomy.

Ahmed T, Kayani N, Ahmad Z, Haque MN
Non-Hodgkin's thyroid lymphoma associated with Hashimoto's thyroiditis.
J Pak Med Assoc. 2014; 64(3):342-4 [PubMed] Related Publications
We report two cases of thyroid lymphoma. First was of a 54-year-old lady who presented with a 10 year history of goiter. Examination revealed an enlarged thyroid gland extending sub-sternally, with no palpable lymph nodes. She had been on thyroxine for 4 months, due to a high TSH with positive antibodies. Fine needle aspiration cytology of thyroid showed Hashimoto thyroiditis (HT). A total thyroidectomy was done because of pressure symptoms. Histopathology revealed HT in right lobe and Diffuse Large B-cell Non-Hodgkin's lymphoma (DLBCL) in left lobe. Second case was of a 30 year-old man who presented with dyspnoea secondary to rapidly enlarging thyroid. On examination, thyroid was diffusely enlarged together with palpable lymph nodes. His TSH was elevated & Anti-TPO antibodies were positive suggesting an autoimmune etiology. Ultrasound showed, an ill-defined heterogeneous mass in the left lobe of thyroid gland with multiple enlarged lymph nodes. Ultrasound guided thyroid core biopsy revealed DLBCL.

Related: Non Hodgkin's Lymphoma Thyroid Cancer

Baxi SS, Pinheiro LC, Patil SM, et al.
Causes of death in long-term survivors of head and neck cancer.
Cancer. 2014; 120(10):1507-13 [PubMed] Related Publications
BACKGROUND: Survivors of head and neck squamous cell carcinoma (HNSCC) face excess mortality from multiple causes.
METHODS: We used the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry data to evaluate the causes of death in patients with nonmetastatic HNSCC diagnosed between 1992 and 2005 who survived at least 3 years from diagnosis (long-term survivors). We used competing-risks proportional hazards regression to estimate probabilities of death from causes: HNSCC, second primary malignancy (SPM) excluding HNSCC, cardiovascular disease, and other causes.
RESULTS: We identified 35,958 three-year survivors of HNSCC with a median age at diagnosis of 60 years (range = 18-100 years) and a median follow-up of 7.7 years (range = 3-18 years). There were 13,120 deaths during the study period. Death from any cause at 5 and 10 years was 15.4% (95% confidence interval [CI] = 15.0%-15.8%) and 41.0% (95% CI = 40.4%-41.6%), respectively. There were 3852 HNSCC deaths including both primary and subsequent head and neck tumors. The risk of death from HNSCC was greater in patients with nasopharynx or hypopharynx cancer and in patients with locally advanced disease. SPM was the leading cause of non-HNSCC death, and the most common sites of SPM death were lung (53%), esophagus (10%), and colorectal (5%) cancer.
CONCLUSIONS: Many long-term HNSCC survivors die from cancers other than HNSCC and from noncancer causes. Routine follow-up care for HNSCC survivors should expand beyond surveillance for recurrent and new head and neck cancers.

Related: USA

Mazibrada J, Longo L, Vatrano S, et al.
Differential expression of HER2, STAT3, SOX2, IFI16 and cell cycle markers during HPV-related head and neck carcinogenesis.
New Microbiol. 2014; 37(2):129-43 [PubMed] Related Publications
The aim of this study was to analyze protein and gene expression of HER2 in 224 head and neck precancerous and malignant lesions by immunohistochemistry and FISH analysis. In parallel, expression of pStat3, Sox2, IFI16 and p16, Ki67 was evaluated. Immunohistochemical analysis was assessed on formalin-fixed paraffin-embedded (FFPE) tissue specimens. A combined method for HPV detection consisting of p16 immunostaining and two PCR probes was applied. HER2 gene status was evaluated by FISH analysis. HPV DNA was detected in 24% of cases with predominant HPV16 genotype. HPV-positive lesions had higher HER2, pStat3 and within carcinoma group, and higher IFI16 expression compared to the HPV-negative group (Fig. 1A-B-C). A strong positive correlation between Sox2 and proliferative activity was observed, whereas IFI16 expression displayed a negative relationship with Sox2 and Ki67 activity. The most striking result was higher pStat3 expression in HPV-positive lesions and its strong positive correlation with IFI16 expression. The presence of HPV may induce upregulation of HER2/neu, pStat3 and IFI16. High levels and a strong positive correlation between pStat3 and IFI16 suggest their synergistic pro-apoptotic effects in HPV-positive lesions.

Conzo G, Calò PG, Sinisi AA, et al.
Impact of prophylactic central compartment neck dissection on locoregional recurrence of differentiated thyroid cancer in clinically node-negative patients: a retrospective study of a large clinical series.
Surgery. 2014; 155(6):998-1005 [PubMed] Related Publications
BACKGROUND: In clinically node-negative patients with differentiated thyroid cancer (DTC), indications for routine central lymph node dissection (RCLD) are the subject of intensive research, and surgeons are divided between the pros and cons of this surgery. To better define the role of neck dissection in the treatment of DTC, we analyzed retrospectively the results in three centers in Italy.
METHODS: The clinical records of 752 clinically node-negative patients with DTC who underwent operative treatment between January 1998 and December 2005 in three endocrine surgery referral units were evaluated retrospectively. The complications and medium- and long-term outcomes of total thyroidectomy (TT) alone (performed in 390 patients: group A) and TT combined with bilateral RCLD (362 patients: group B) were analyzed and compared.
RESULTS: The incidence of permanent hypoparathyroidism and permanent unilateral vocal folds was 1% and 0.8% in group A and 3.6% and 1.7% in the group B, respectively. Bilateral temporary recurrent nerve palsy was observed in one of the 362 patients in group B. After a follow-up of 9.5 ± 3.5 years (mean ± SD), the locoregional recurrence rate with positive cervical lymph nodes was not substantially significantly different between the two groups.
CONCLUSION: In our series, TT combined with bilateral RCLD was associated with a greater rate of transient and permanent complications. Similar incidences of locoregional recurrence were reported in the two groups of patients. Considering the recent trend toward routine central lymphadenectomy, further studies are needed to evaluate the benefits of these different approaches.

Related: Thyroid Cancer

Scott A
Polymeric membrane dressings for radiotherapy-induced skin damage.
Br J Nurs. 2014 May 22-Jun 11; 23(10):S24, S26-31 [PubMed] Related Publications
Radiotherapy is one of the mainline treatments for cancer. One of the side effects associated with radiotherapy includes skin problems, which range from mild (dull erythema and tightening of the skin) to severe (moist desquamation resulting in open wounds that can be very painful associated with sloughy and, in some severe cases, necrosis). The increased use of advanced radical treatments, such as intensity-modulated radiotherapy treatment (IMRT), can also result in a higher number of patients experiencing skin reactions. It is estimated that approximately 87% of patients will experience a moderate-to-severe skin reaction (Harris et al, 2011) An evaluation was undertaken in 20 patients with head and neck cancer following a prescribed treatment of radiotherapy to compare a polymeric membrane dressing (PolyMem®) against the standard treatment. The standard treatment consisted of topical aqueous cream at the start of radiotherapy with the addition of paraffin gauze when moist desquamation occurred. A bespoke evaluation form was completed for a period of 4 weeks or until healed. Patients were asked to complete both qualitative descriptions and numerical scores of pain for symptoms and procedural pain. Analgesia and sleep patterns were logged and, in addition, free text diaries were provided for up to 4 weeks. Common themes were identified and qualitative data analysed.

Milenović A, Virag M, Knezević P, et al.
Evaluation of sentinel node biopsy in oral carcinomas.
Coll Antropol. 2014; 38(1):279-82 [PubMed] Related Publications
It is still a matter of debate whether sentinel node biopsy might replace neck dissection in patients with clinically negative neck lymph nodes who suffer from oral squamous cell carcinoma. In 30 patients (26 male, 4 female, average age 59.4 years) with oral squamous cell carcinoma we performed ultrasound guided punction of the lymph nodes which were lymphoscintigraphically seen together with histopatological analysis of the dissected node. Sentinel lymph node was seen in 93% cases. By use of lymphoscintigraphy sentinel node was verified in 23 patients. Ultrasound guided punction showed presence of regional disease in 10% of cases, whereas sentinel biopsy revealed 23 of the converted necks. Histopathological findings were positive in 33% of our patients. The results of this study revealed that sentinel biopsy did not reveal 27% of the patients with positive neck histopathology. In conclusion, sentinel node biopsy should be performed in selective cases as in some localizations it is easier to perform neck dissection in comparison to the sentinel node biopsy.

Related: Oral Cancer

Dogra VS, Chinni BK, Valluru KS, et al.
Preliminary results of ex vivo multispectral photoacoustic imaging in the management of thyroid cancer.
AJR Am J Roentgenol. 2014; 202(6):W552-8 [PubMed] Related Publications
OBJECTIVE: The purpose of this study was to validate whether ex vivo multispectral photoacoustic imaging can be used to differentiate malignant tissue, benign nodules, and normal human thyroid tissue.
SUBJECTS AND METHODS: Fifty patients undergoing thyroidectomy because of thyroid lesions participated in this study. Multispectral photoacoustic imaging was performed on surgically excised thyroid tissue, and chromophore images that represented optical absorption of deoxyhemoglobin, oxyhemoglobin, lipid, and water were reconstructed. After the imaging procedure, the pathologist marked malignant tissue, benign nodules, and normal regions on histopathologic slides, and digital images of the marked histopathologic slides were obtained. The histopathologic images were coregistered with chromophore images. Areas corresponding to malignant tissue, benign nodules, and normal tissue were defined on the chromophore images. Pixel values within each area were averaged to determine the mean intensities of deoxyhemoglobin, oxyhemoglobin, lipid, and water.
RESULTS: There was a statistically significant difference between malignant and benign nodules with respect to mean intensity of deoxyhemoglobin (p = 0.014). There was a difference between malignant and normal tissue in mean intensity of deoxyhemoglobin (p = 0.003), lipid (p = 0.001), and water (p < 0.0001). A difference between benign nodules and normal tissue was found in mean intensity of oxyhemoglobin (p < 0.0001), lipid (p < 0.0001), and water (p < 0.0001). The sensitivity, specificity, and positive and negative predictive values of the system tested in differentiating malignant from nonmalignant thyroid tissue were 69.2%, 96.9%, 81.8%, and 93.9%.
CONCLUSION: The preliminary results of this ex vivo human thyroid study suggest that multispectral photoacoustic imaging can be used to differentiate malignant and benign nodules and normal human thyroid tissue.

Related: Thyroid Cancer

Marcus C, Whitworth PW, Surasi DS, et al.
PET/CT in the management of thyroid cancers.
AJR Am J Roentgenol. 2014; 202(6):1316-29 [PubMed] Related Publications
OBJECTIVE: Thyroid cancer is the most common endocrine cancer. This review evaluates the established use of (18)F-FDG PET/CT in papillary, follicular, Hürthle cell, anaplastic, and medullary thyroid cancers. The significance of incidental diffuse and focal thyroid FDG uptake is discussed. The evolving value of non-FDG radiotracers, including (124)I, (18)F-dihydroxyphenylalanine, and (68)Ga somatostatin analogs, is summarized.
CONCLUSION: PET/CT is a valuable imaging test, in the appropriate clinical context, for the management of thyroid cancers.

Related: Thyroid Cancer

Kolude B, Adisa A, Adeyemi B, Lawal A
Stages of delay in oral cancer care evaluated at a tertiary health centre.
Afr J Med Med Sci. 2013; 42(4):347-53 [PubMed] Related Publications
BACKGROUND: To examine the stages of delay in presentation and management of oral cancer patients at University College Hospital Ibadan and compare findings with previous studies.
METHODS: A 20-year retrospective analysis of the delay stages among oral cancer patients that utilized patient's biodata and clinical data.
RESULT: 169 oral cancer cases consisting of 127 carcinomas, 25 sarcomas and 17 lymphomas were analyzed. There was significant difference in the mean evolution time (ET) according to histological type (oral carcinoma = 282.8 +/- 414, oral sarcomas = 219.2 +/- 247.3 and oral lymphomas 105.5 +/- 115 days; p = 0.001). Patient's delay was more than professional delay for all cancer types (65.9%, 59.1% and 60.1% for carcinomas, sarcomas and lymphomas respectively). There was a significant difference in the mean ET of the early stage cancers compared with the late stage cancers (mean = 137.2 +/- 99 and 266.4 +/- 355; p = 0.010).
CONCLUSION: A combination of patients and professional delay negatively influenced the management of oral cancer patients but the patient's delay formed the bulk of this combination in our center.

Related: Oral Cancer

Akinyamoju AO, Adeyemi BF, Kolude B, Adisa AO
Histological grading of oral squamous cell carcinoma patients in Ibadan using Bryne's and Broders' grading systems--a comparative study.
Afr J Med Med Sci. 2013; 42(4):333-7 [PubMed] Related Publications
BACKGROUND: Several histological grading systems for oral squamous cell carcinoma (OSCC) have been used previously to guide treatment and prognostication, amongst which are the Broders and the Bryne's methods. The Bryne's invasive tumour front (ITF) protocol has been adjudged to have good prognostic significance. We compared the use of Bryne's ITF system and Broders' grading system in grading OSCC at our centre in relation to clinico-demographic profile of patients.
METHODS: Thirty two formalin fixed paraffin embedded (FFPE) tissue samples of histologically diagnosed OSCC patients at the University College Hospital (UCH) Ibadan were selected, demographic data and site of lesions were retrieved from the medical records of the patients. The haematoxylin and eosin (H&E) slides of the 32 cases were prepared and evaluated using Bryne's ITF system and Broders classification.
RESULTS: Using Bryne's system, 28% of the cases had a high malignancy score while 72% had a low malignancy score. The high malignancy score lesions were most commonly seen in the palate (15.5%). Also Broders classification showed that 31.3% of cases were well differentiated tumours, 50% were moderately differentiated while 18.7% were poorly differentiated.
CONCLUSION: Either the Bryne's system or Broders classification can be used to grade OSCC with similar results being obtained.

Related: Oral Cancer

Elledge R, Elledge RO, Raskauskiene D
Metastatic involvement of the maxillary antrum from an uncommon source.
Dent Update. 2014; 41(3):230-2, 235 [PubMed] Related Publications
Metastatic involvement of the jawbones is uncommon, particularly in the maxilla. Case reports of such metastases from renal cell primaries are few, making a consensus on treatment difficult to establish. We present a case of metastatic involvement of the maxilla two years following a nephrectomy for renal cell carcinoma. The case exemplifies the broad range of symptoms attributable to metastases in the maxilla and the management dilemmas. Clinical Relevance: The case highlights the role of practitioners in primary dental care in identifying the potential for such pathology based on clinical and radiographic features.

Related: Kidney Cancer Sorafenib (Nexavar) Sunitinib (Sutent)

Henry M, Ho A, Lambert SD, et al.
Looking beyond disfigurement: the experience of patients with head and neck cancer.
J Palliat Care. 2014; 30(1):5-15 [PubMed] Related Publications
Despite the frequent occurrence of head and neck cancer (HNC) disfigurement, little is known about its psychosocial impact on patients. This study aimed to understand the lived experience of disfigurement in HNC and explore what patients considered to be its influences. Fourteen disfigured HNC patients participated in a 45-to-120-minute in-depth, semistructured interview, which was analyzed qualitatively using interpretive phenomenology. A majority of participants (64 percent) were considered to be at an advanced cancer stage (stage III or stage IV). Patients' experiences revolved around the concept of a ruptured self-image (a discontinuity in sense of self). Forces triggering this ruptured self-image created a sense of "embodied angst", in which disfigurement served as a constant reminder of the patient's cancer and associated foundational malaise. Other influences fostered a sense of normalcy, balance, and acceptance. Participants oscillated between these two states as they grew to accept their disfigurement. This study's findings could guide supportive interventions aimed at helping patients face head and neck surgery.

Dixon AJ, Anderson SJ, Mazzurco JD, Steinman HK
Novel photodynamic therapy does not prevent new skin cancers--randomized controlled trial.
Dermatol Surg. 2014; 40(4):412-9 [PubMed] Related Publications
OBJECTIVES: To determine whether field photodynamic therapy (PDT) of actinic keratoses using a novel preparation of 5-aminolevulonic acid (novel ALA) results in fewer subsequent invasive skin cancers developing on the face of individuals with previous facial cutaneous malignancy in a prospective randomized controlled trial.
METHODS AND MATERIALS: Intervention patients received two treatments of novel ALA 2 weeks apart. Controls were observed. Patients were followed up with biopsy of any suspicious lesions for 3 years.
RESULTS: The trial was suspended early because of problems with trial governance and the reporting of severe adverse events. Sixty-four patients who were recruited at that time at one center were monitored. Their average age was 71, and 57% were male. Patients were randomized to intervention (n = 34) or observation (n = 29). Over the subsequent 3 years, 13 intervention patients (38%) developed 30 new cutaneous malignancies in the field treated, and 11 control patients (38%) developed 22 new malignancies. Some intervention patients experienced prolonged adverse events, including permanent scarring.
CONCLUSION: Novel ALA made no difference in the likelihood of new malignancies developing. The risks without benefit of this novel ALA are troubling. Lack of efficacy and safety of novel ALA cannot be extrapolated to other PDT products.

Related: Basal Cell Carcinoma Melanoma Skin Cancer

Rinaldi S, Plummer M, Biessy C, et al.
Thyroid-stimulating hormone, thyroglobulin, and thyroid hormones and risk of differentiated thyroid carcinoma: the EPIC study.
J Natl Cancer Inst. 2014; 106(6):dju097 [PubMed] Related Publications
BACKGROUND: Increased levels of thyroglobulin (Tg) and thyroid-stimulating hormone (TSH) are associated with differentiated thyroid carcinoma (TC) risk, but strong epidemiological evidence is lacking.
METHODS: Three hundred fifty-seven incident TC case patients (n = 300 women and 57 men; mean age at blood collection = 51.5 years) were identified in the EPIC cohort study and matched with 2 (women) or 3 (men) control subjects using incidence density sampling. Matching included study center, sex, age, date, time, and fasting status at blood collection. Levels of total and free (f) thyroxine (T4) and triiodo-thyronine (T3), TSH, Tg, and anti-Tg antibodies (TgAb) were measured by commercially available immunoassays. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using conditional logistic regression. All statistical tests were two-sided.
RESULTS: TC risk was positively associated with Tg (OR for the highest vs lowest quartile = 9.15; 95% CI = 5.28 to 15.90; P < .001) and negatively associated with TSH level (OR = 0.56; 95% CI = 0.38 to 0.81; P = .001). Odds ratios were not modified by adjustment for weight and height and were consistent across sexes, age groups, and countries. The association with Tg was stronger in follicular than papillary TC. The odds ratio for TgAb-positivity was 1.50 (95% CI = 1.05 to 2.15; P = .03). Among case patients, TSH level was stable over time, whereas Tg level was higher in proximity to TC diagnosis. Areas under the receiver operating characteristic curve were 57% and 74% for TSH and Tg level, respectively.
CONCLUSIONS: High Tg levels precede by up to 8 years the detection of TC, pointing to a long sojourn time of the disease. Low TSH levels may predispose to TC onset. Neither marker has sufficient accuracy to be a screening test.

Related: Thyroid Cancer

Qiang W, Jin T, Yang Q, et al.
PRIMA-1 selectively induces global DNA demethylation in p53 mutant-type thyroid cancer cells.
J Biomed Nanotechnol. 2014; 10(7):1249-58 [PubMed] Related Publications
The p53 tumor suppressor pathway blocks carcinogenesis by triggering apoptosis and cellular senescence in response to oncogenic stress. Over 50% of human cancers including thyroid cancer carry loss-of-function mutations in the p53 gene. Recently, the identification of mutant p53-reactivating small molecules such as PRIMA-1 (p53 reactivation and induction of massive apoptosis) renders possibilities for the development of more efficient anticancer drugs. Although PRIMA-1 has been widely used for cancer therapy and exhibits a promising anticancer activity, its biological effect, particularly the epigenetic aspect, remains to be well elucidated. The present study attempts to explore the effect of PRIMA-1 on DNA methylation in a panel of thyroid cancer cell lines using luminometric methylation assay (LUMA). Our results showed that only p53 mutant-type cells were inhibited upon PRIMA-1 treatment. Conversely, p53 wild-type cells were non-sensitive to PRIMA-1. Moreover, our data demonstrated that PRIMA-1 selectively induced significant global DNA demethylation in p53 mutant-type cells. Mechanically, PRIMA-1 induced global DNA demethylation in these cells mainly through inhibiting the expression of DNA methyltransferase (DNMT) 1, 3a and 3b, and upregulating the expression of GADD45a. Notably, PRIMA-1 dramatically increased the expression of the ten-eleven translocation (TET) family of 5mC-hydroxylases, particularly TET1, in p53 mutant-type cells, further contributing to DNA demethylation. Thus, this study uncovered a previously unrecognized and prominent biological effect of PRIMA-1 through which it can cause global DNA demethylation in p53 mutant-type cancer cells mainly by rescuing the function of mutant p53 protein.

Related: CDKN1A Thyroid Cancer TP53 TET1

Smith RC, Creighton N, Lord RV, et al.
Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001-2008.
Med J Aust. 2014; 200(7):408-13 [PubMed] Related Publications
OBJECTIVES: To examine the relationship between hospital volume and patient outcomes for New South Wales hospitals performing oesophagectomy and gastrectomy for oesophagogastric cancer.
DESIGN, SETTING AND PATIENTS: A retrospective, population-based cohort study of NSW residents diagnosed with a new case of invasive oesophageal or gastric cancer who underwent oesophagectomy or gastrectomy between 2001 and 2008 in NSW hospitals using linked de-identified data from the NSW Central Cancer Registry, the National Death Index and the NSW Admitted Patient Data Collection. A higher-volume hospital was defined as one performing > 6 relevant procedures per year.
MAIN OUTCOME MEASURES: Odds ratios for > 21-day length of stay, 28-day unplanned readmission, 30-day mortality and 90-day mortality, and hazard ratios (HRs) for 5-year absolute and conditional survival.
RESULTS: Oesophagectomy (908 patients) and gastrectomy (1621 patients) were undertaken in 42 and 84 hospitals, respectively, between 2001 and 2008. Median annual hospital volume ranged from 2 to 4 for oesophagectomies and ranged from 2 to 3 for gastrectomies. Controlling for known confounders, no associations between hospital volume and > 21-day length of stay and 28-day unplanned readmission were found. Overall 30-day mortality was 4.1% and 4.4% for oesophagectomy and gastrectomy, respectively. Five-year absolute survival was significantly better for patients who underwent oesophagectomy in higher-volume hospitals (adjusted HR for lower-volume hospitals, 1.28 [95% CI, 1.10-1.49]; P = 0.002) and for those with localised gastric cancer who underwent gastrectomy in higher-volume hospitals (adjusted HR for lower-volume hospitals, 1.83 [95% CI, 1.28-2.61]; P = 0.001).
CONCLUSIONS: These data support initial surgery for oesophagogastric cancer in higher-volume hospitals.

Related: Cancer of the Esophagus Esophageal Cancer Stomach Cancer Gastric Cancer

Friedman G, Copeland H, Astudillo JA, et al.
Laparoscopic management of obstructed gastric conduit after minimally invasive esophagectomy.
Ann Thorac Surg. 2014; 97(5):e145-6 [PubMed] Related Publications
We describe a novel, minimally invasive method of managing an obstructed gastric conduit after minimally invasive esophagectomy. In addition, we briefly review the management of obstructed gastric conduit in patients status-post minimally invasive esophagectomy. On literature review, it was noted that gastrojejunostomy after esophagectomy was exceptionally rare. Only one other reported case of gastrojejunostomy after esophagectomy was found in the literature. This is the first reported case to our knowledge of laparoscopic gastrojejunostomy after minimally invasive esophagectomy (MIE). Laparoscopic gastrojejunostomy after minimally invasive esophagectomy for obstructed gastric conduit is technically feasible, and it effectively managed the obstruction in our patient.

Related: Cancer of the Esophagus Esophageal Cancer

Zhang Z, Mao Y, Chen H, et al.
Endotracheal and endobronchial metastases in a patient with stage I lung adenocarcinoma.
Ann Thorac Surg. 2014; 97(5):e135-7 [PubMed] Related Publications
Endotracheal or endobronchial metastasis from primary lung cancer is extremely rare. We report a case of endotracheal and endobronchial metastases from peripheral early lung adenocarcinoma 7 months after complete resection. The patient harbored the same gene mutation in both primary and metastatic lesions. This report highlights that enough attention on endotracheal metastases should be paid no matter what the pathologic TNM stage of primary lung cancer is.

Yu JY, Oh IJ, Kim KS, et al.
Castleman's disease presenting as a tracheal mass.
Ann Thorac Surg. 2014; 97(5):1798-800 [PubMed] Related Publications
Castleman's disease (CD) is a rare lymphoproliferative disorder of uncertain cause. The most common site of involvement is the mediastinum. Endotracheal CD is extremely rare. We report a case of unicentric, hyaline-vascular type CD presenting as an obstructive tracheal mass. The tumor was successfully managed by rigid bronchoscopy with argon plasma coagulation. There was no recurrence at the 2-month follow-up visit.

Related: Tracheal (windpipe) Cancer

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